Abstract：
OBJECTIVE: The aim of this study was to perform a head-to-head comparison of multiparametric MRI (mpMRI) and the combination of prostate-specific membrane antigen (PSMA) PET plus MRI (PSMA + MRI) for detecting intraprostatic clinically significant prostate cancer (csPCa).
METHODS: Relevant databases were searched through November 2023. Only studies directly comparing mpMRI and PSMA + MRI (PET/MRI or PET/CT + mpMRI) were included. A meta-analysis with a random-effects model was used to estimate pooled sensitivity, specificity, and area under the curve for each approach.
RESULTS: A total of 19 studies were included. On a patient-level analysis, PSMA + MRI had higher sensitivity (9 studies) than mpMRI for csPCa detection (96% [95% confidence interval (CI): 92%, 98%] vs 89% [95% CI: 81%, 94%]; P = 0.04). The patient-level specificity (4 studies) of PSMA + MRI was 55% (95% CI: 31%-76%) compared with 50% (95% CI: 44%-57%) of mpMRI ( P = 0.67). Region-level sensitivity (10 studies) was 85% (95% CI: 74%-92%) for PSMA + MRI and 71% (95% CI: 58%-82%) for mpMRI ( P = 0.09), whereas specificity (4 studies) was 87% (95% CI: 76%-94%) and 90% (95% CI: 82%-95%), respectively ( P = 0.59). Lesion-level sensitivity and specificity were similar between modalities with pooled data from less than 4 studies.
CONCLUSIONS: PSMA + MRI had superior pooled sensitivity and similar specificity for the detection of csPCa compared with mpMRI in this meta-analysis of head-to-head studies.
METHODS: Relevant databases were searched through November 2023. Only studies directly comparing mpMRI and PSMA + MRI (PET/MRI or PET/CT + mpMRI) were included. A meta-analysis with a random-effects model was used to estimate pooled sensitivity, specificity, and area under the curve for each approach.
RESULTS: A total of 19 studies were included. On a patient-level analysis, PSMA + MRI had higher sensitivity (9 studies) than mpMRI for csPCa detection (96% [95% confidence interval (CI): 92%, 98%] vs 89% [95% CI: 81%, 94%]; P = 0.04). The patient-level specificity (4 studies) of PSMA + MRI was 55% (95% CI: 31%-76%) compared with 50% (95% CI: 44%-57%) of mpMRI ( P = 0.67). Region-level sensitivity (10 studies) was 85% (95% CI: 74%-92%) for PSMA + MRI and 71% (95% CI: 58%-82%) for mpMRI ( P = 0.09), whereas specificity (4 studies) was 87% (95% CI: 76%-94%) and 90% (95% CI: 82%-95%), respectively ( P = 0.59). Lesion-level sensitivity and specificity were similar between modalities with pooled data from less than 4 studies.
CONCLUSIONS: PSMA + MRI had superior pooled sensitivity and similar specificity for the detection of csPCa compared with mpMRI in this meta-analysis of head-to-head studies.
摘要：
目的：这项研究的目的是进行多参数MRI（mpMRI）和前列腺特异性膜抗原（PSMA）PET加MRI（PSMAMRI）的组合的头对头比较，以检测前列腺内临床上有意义的前列腺癌（csPCa）。
方法：到2023年11月检索相关数据库。仅包括直接比较mpMRI和PSMA+MRI（PET/MRI或PET/CT+mpMRI）的研究。使用随机效应模型的荟萃分析来估计合并敏感性，特异性，以及每种方法的曲线下面积。
结果：共纳入19项研究。在患者层面的分析中，PSMA+MRI对csPCa检测的灵敏度(9项研究)高于mpMRI(96%[95%置信区间(CI):92%,98%]vs89%[95%CI：81%，94%]；P=0.04）。PSMA+MRI的患者水平特异性（4项研究）为55％（95％CI：31％-76％），而mpMRI为50％（95％CI：44％-57％）（P=0.67）。PSMA+MRI的区域水平敏感性（10项研究）为85％（95％CI：74％-92％），mpMRI为71％（95％CI：58％-82％）（P=0.09），而特异性（4项研究）为87%（95%CI：76%-94%）和90%（95%CI：82%-95%），分别为(P=0.59)。病变水平的敏感性和特异性与来自少于4项研究的合并数据相似。
结论：在这项头对头研究的荟萃分析中，与mpMRI相比，PSMA+MRI对csPCa的检测具有更高的合并敏感性和相似的特异性。
方法：到2023年11月检索相关数据库。仅包括直接比较mpMRI和PSMA+MRI（PET/MRI或PET/CT+mpMRI）的研究。使用随机效应模型的荟萃分析来估计合并敏感性，特异性，以及每种方法的曲线下面积。
结果：共纳入19项研究。在患者层面的分析中，PSMA+MRI对csPCa检测的灵敏度(9项研究)高于mpMRI(96%[95%置信区间(CI):92%,98%]vs89%[95%CI：81%，94%]；P=0.04）。PSMA+MRI的患者水平特异性（4项研究）为55％（95％CI：31％-76％），而mpMRI为50％（95％CI：44％-57％）（P=0.67）。PSMA+MRI的区域水平敏感性（10项研究）为85％（95％CI：74％-92％），mpMRI为71％（95％CI：58％-82％）（P=0.09），而特异性（4项研究）为87%（95%CI：76%-94%）和90%（95%CI：82%-95%），分别为(P=0.59)。病变水平的敏感性和特异性与来自少于4项研究的合并数据相似。
结论：在这项头对头研究的荟萃分析中，与mpMRI相比，PSMA+MRI对csPCa的检测具有更高的合并敏感性和相似的特异性。
